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(a) The following criteria shall be used in determining the value of property or amount of physical harm involved in a violation of Section 542.09:
(1) If the property is an heirloom, memento, collector’s item, antique, museum piece, manuscript, document, record, or other thing that is either irreplaceable or is replaceable only on the expenditure of substantial time, effort, or money, the value of the property or the amount of physical harm involved is the amount that would compensate the owner for its loss.
(2) If the property is not covered under division (a)(1) of this section, and the physical harm is such that the property can be restored substantially to its former condition, the amount of physical harm involved is the reasonable cost of restoring the property.
(3) If the property is not covered under division (a)(1) of this section, and the physical harm is such that the property cannot be restored substantially to its former condition, the value of the property, in the case of personal property, is the cost of replacing the property with new property of like kind and quality, and in the case of real property or real property fixtures, is the difference in the fair market value of the property immediately before and immediately after the offense.
(b) As used in this section, “fair market value” has the same meaning as in Ohio R.C. 2913.61.
(c) Prima facie evidence of the value of property, as provided in Ohio R.C. 2913.61(D), may be used to establish the value of property pursuant to this section.
(ORC 2909.11(B) - (D))
(a) In a prosecution for a theft offense, as defined in Ohio R.C. 2913.01, that involves alleged tampering with a gas, electric, steam or water meter, conduit or attachment of a utility that has been disconnected by the utility, proof that a meter, conduit or attachment of a utility has been tampered with is prima facie evidence that the person who is obligated to pay for the service rendered through the meter, conduit or attachment, and who is in possession or control of the meter, conduit or attachment at the time the tampering occurred has caused the tampering with intent to commit a theft offense.
(b) In a prosecution for a theft offense, as defined in Ohio R.C. 2913.01, that involves the alleged reconnection of a gas, electric, steam or water meter, conduit or attachment of a utility that has been disconnected by the utility, proof that a meter, conduit or attachment disconnected by a utility has been reconnected without the consent of the utility is prima facie evidence that the person in possession or control of the meter, conduit or attachment at the time of the reconnection has reconnected the meter, conduit or attachment with intent to commit a theft offense.
(c) As used in this section:
(1) “Utility” means any electric light company, gas company, natural gas company, pipe-line company, water-works company or heating or cooling company, as defined in Ohio R.C. 4905.03, its lessees, trustees or receivers, or any similar utility owned or operated by a political subdivision.
(2) “Tamper” means to interfere with, damage or bypass a utility meter, conduit or attachment with the intent to impede the correct registration of a meter or the proper functions of a conduit or attachment so as to reduce the amount of utility service that is registered on the meter.
(ORC 4933.18)
(d) Each electric light company, gas company, natural gas company, pipeline company, waterworks company or heating or cooling company, as defined by Ohio R.C. 4905.03, or its lessees, trustees or receivers, and each similar utility owned or operated by a political subdivision, shall notify its customers, on an annual basis, that tampering with or bypassing a meter constitutes a theft offense that could result in the imposition of criminal sanctions.
(ORC 4933.19)
(a) For the purpose of this section, the following definitions shall apply unless the context clearly indicates or requires a different meaning.
(1) “Data” has the same meaning as in Ohio R.C. 2913.01 and additionally includes any other representation of information, knowledge, facts, concepts, or instructions that are being or have been prepared in a formalized manner.
(2) “Deceptive” means that a statement, in whole or in part, would cause another to be deceived because it contains a misleading representation, withholds information, prevents the acquisition of information, or by any other conduct, act, or omission creates, confirms, or perpetuates a false impression, including, but not limited to, a false impression as to law, value, state of mind, or other objective or subjective fact.
(3) “Insurer” means any person that is authorized to engage in the business of insurance in this State under Ohio R.C. Title 39, the Ohio Fair Plan Underwriting Association created under Ohio R.C. 3929.43, any health insuring corporation, and any legal entity that is self-insured and provides benefits to its employees or members.
(4) “Policy” means a policy, certificate, contract, or plan that is issued by an insurer.
(5) “Statement” includes but is not limited to any notice, letter, or memorandum; proof of loss; bill of lading; receipt for payment; invoice, account, or other financial statement; estimate of property damage; bill for services; diagnosis or prognosis; prescription; hospital, medical, or dental chart or other record; x-ray, photograph, videotape, or movie film; test result; other evidence of loss, injury, or expense; computer-generated document; and data in any form.
(b) No person, with purpose to defraud or knowing that the person is facilitating a fraud, shall do either of the following:
(1) Present to, or cause to be presented to, an insurer any written or oral statement that is part of, or in support of, an application for insurance, a claim for payment pursuant to a policy, or a claim for any other benefit pursuant to a policy, knowing that the statement, or any part of the statement, is false or deceptive;
(2) Assist, aid, abet, solicit, procure, or conspire with another to prepare or make any written or oral statement that is intended to be presented to an insurer as part of, or in support of, an application for insurance, a claim for payment pursuant to a policy, or a claim for any other benefit pursuant to a policy, knowing that the statement, or any part of the statement, is false or deceptive.
(c) Whoever violates this section is guilty of insurance fraud. Except as otherwise provided in this division, insurance fraud is a misdemeanor of the first degree. If the amount of the claim that is false or deceptive is one thousand dollars ($1,000) or more, insurance fraud is a felony to be prosecuted under appropriate State law.
(d) This section shall not be construed to abrogate, waive, or modify Ohio R.C. 2317.02(A).
(ORC 2913.47)
(a) No person, with purpose to defraud or knowing that the person is facilitating a fraud shall do any of the following:
(1) Receive workers’ compensation benefits to which the person is not entitled;
(2) Make or present or cause to be made or presented a false or misleading statement with the purpose to secure payment for goods or services rendered under Ohio R.C. Chapter 4121, 4123, 4127, or 4131 or to secure workers’ compensation benefits;
(3) Alter, falsify, destroy, conceal, or remove any record or document that is necessary to fully establish the validity of any claim filed with, or necessary to establish the nature and validity of all goods and services for which reimbursement or payment was received or is requested from the Bureau of Workers’ Compensation, or a self-insuring employer under Ohio R.C. Chapter 4121, 4123, 4127, or 4131;
(4) Enter into an agreement or conspiracy to defraud the Bureau of Workers’ Compensation or a self-insuring employer by making or presenting or causing to be made or presented a false claim for workers’ compensation benefits.
(b) Whoever violates this section is guilty of workers’ compensation fraud. Except as otherwise provided in this division, workers’ compensation fraud is a misdemeanor of the first degree. If the value of the goods, services, property, or money stolen is one thousand dollars ($1,000) or more, workers’ compensation fraud is a felony to be prosecuted under appropriate State law.
(c) Upon application of the governmental body that conducted the investigation and prosecution of a violation of this section, the court shall order the person who is convicted of the violation to pay the governmental body its costs of investigating and prosecuting the case. These costs are in addition to any other costs or penalty provided under Federal, State or local law.
(d) The remedies and penalties provided in this section are not exclusive remedies and penalties and do not preclude the use of any other criminal or civil remedy or penalty for any act that is in violation of this section.
(e) For the purpose of this section, the following definitions shall apply unless the context clearly indicates or requires a different meaning.
(1) “Claim” means any attempt to cause the Bureau of Workers’ Compensation, an independent third party with whom the administrator or an employer contracts under Ohio R.C. 4121.44, or a self-insuring employer to make payment or reimbursement for workers’ compensation benefits.
(2) “Employer,” “employee,” and “self-insuring employer” have the same meanings as in Ohio R.C. 4123.01.
(3) “Employment” means participating in any trade, occupation, business, service, or profession for substantial gainful remuneration.
(4) “False” means wholly or partially untrue or deceptive.
(5) “Goods” includes but is not limited to medical supplies, appliances, rehabilitative equipment, and any other apparatus or furnishing provided or used in the care, treatment, or rehabilitation of a claimant for workers’ compensation benefits.
(6) “Records” means any medical, professional, financial, or business record relating to the treatment or care of any person, to goods or services provided to any person, or to rates paid for goods or services provided to any person, or any record that the administrator of workers’ compensation requires pursuant to rule.
(7) “Remuneration” includes but is not limited to wages, commissions, rebates, and any other reward or consideration.
(8) “Services” includes but is not limited to any service provided by any health care provider to a claimant for workers’ compensation benefits.
(9) “Statement” includes but is not limited to any oral, written, electronic, electronic impulse, or magnetic communication notice, letter, memorandum, receipt for payment, invoice, account, financial statement, bill for services; a diagnosis, prognosis, prescription, hospital, medical, or dental chart or other record; and a computer generated document.
(10) “Workers’ compensation benefits” means any compensation or benefits payable under Ohio R.C. Chapter 4121, 4123, 4127, or 4131.
(ORC 2913.48)
(a) As used in this section:
(1) “Medical assistance program” means the program established by the Ohio Department of Job and Family Services to provide medical assistance under Ohio R.C. 5111.01 and the Medicaid program of Title XIX of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended.
(2) “Provider” means any person who has signed a provider agreement with the Ohio Department of Job and Family Services to provide goods or services pursuant to the medical assistance program or any person who has signed an agreement with a party to such a provider agreement under which the person agrees to provide goods or services that are reimbursable under the medical assistance program.
(3) “Provider agreement” means an oral or written agreement between the Ohio Department of Job and Family Services and a person in which the person agrees to provide goods or services under the medical assistance program.
(4) “Recipient” means any individual who receives goods or services from a provider under the medical assistance program.
(5) “Records” means any medical, professional, financial or business records relating to the treatment or care of any recipient, to goods or services provided to any recipient, or to rates paid for goods or services provided to any recipient, and any records that are required by the rules of the Ohio Director of Job and Family Services to be kept for the medical assistance program.
(6) “Statement or representation” means any oral, written, electronic, electronic impulse or magnetic communication that is used to identify an item of goods or a service for which reimbursement may be made under the medical assistance program or that states income and expense and is or may be used to determine a rate of reimbursement under the medical assistance program.
(b) No person shall knowingly make or cause to be made a false or misleading statement or representation for use in obtaining reimbursement from the medical assistance program.
(c) No person, with purpose to commit fraud or knowing that the person is facilitating a fraud, shall do either of the following:
(1) Contrary to the terms of the person’s provider agreement, charge, solicit, accept or receive for goods or services that the person provides under the medical assistance program any property, money or other consideration in addition to the amount of reimbursement under the medical assistance program and the person’s provider agreement for the goods or services and any deductibles or co-payments authorized by rules adopted under Ohio R.C. 5111.011 or by any rules adopted pursuant to that section.
(2) Solicit, offer or receive any remuneration, other than any deductibles or co-payments authorized by rules adopted under Ohio R.C. 5111.011 or by any rules adopted pursuant to that section, in cash or in kind, including, but not limited to, a kickback or rebate, in connection with the furnishing of goods or services for which whole or partial reimbursement is or may be made under the medical assistance program.
(d) No person, having submitted a claim for or provided goods or services under the medical assistance program, shall do either of the following for a period of at least six years after a reimbursement pursuant to that claim, or a reimbursement for those goods or services, is received under the medical assistance program:
(1) Knowingly alter, falsify, destroy, conceal or remove any records that are necessary to fully disclose the nature of all goods or services for which the claim was submitted, or for which reimbursement was received, by the person; or
(2) Knowingly alter, falsify, destroy, conceal or remove any records that are necessary to disclose fully all income and expenditures upon which rates of reimbursements were based for the person.
(e) Whoever violates this section is guilty of medicaid fraud. Except as otherwise provided in this division, medicaid fraud is a misdemeanor of the first degree. If the value of the property, services or funds obtained in violation of this section is one thousand dollars ($1,000) or more, medicaid fraud is a felony to be prosecuted under appropriate State law.
(f) Upon application of the governmental agency, office or other entity that conducted the investigation and prosecution in a case under this section, the court shall order any person who is convicted of a violation of this section for receiving any reimbursement for furnishing goods or services under the medical assistance program to which the person is not entitled to pay to the applicant its cost of investigating and prosecuting the case. The costs of investigation and prosecution that a defendant is ordered to pay pursuant to this division shall be in addition to any other penalties for the receipt of that reimbursement that are provided in this section, Ohio R.C. 2913.40 or 5111.03, or any other provision of law.
(g) The provisions of this section are not intended to be exclusive remedies and do not preclude the use of any other criminal or civil remedy for any act that is in violation of this section.
(ORC 2913.40)
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